{
"Npi": {
"NPI": "1235182767",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TENDER LOVING CARE HEALTH CARE SERVICES OF GEORGIA, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3854 AMERICAN WAY STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BATON ROUGE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70816-4897",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "225-299-3701",
"MailingAddressFaxNumber": "225-295-9678",
"FirstLinePracticeLocationAddress": "3505 DULUTH PARK LN",
"SecondLinePracticeLocationAddress": "SUITE 300",
"PracticeLocationAddressCityName": "DULUTH",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30096-3201",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-417-1033",
"PracticeLocationAddressFaxNumber": "770-622-9870",
"EnumerationDate": "05/18/2006",
"LastUpdateDate": "11/14/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOFF",
"AuthorizedOfficialFirstName": "PATRICIA",
"AuthorizedOfficialMiddleName": "U",
"AuthorizedOfficialTitle": "DELEGATED OFFICIAL",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "225-299-3701",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "060286",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}